Healthcare Provider Details

I. General information

NPI: 1649038357
Provider Name (Legal Business Name): MARSINLEN BLACKWELL COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LACKAWANNA AVE
SCRANTON PA
18503-1953
US

IV. Provider business mailing address

201 LACKAWANNA AVE
SCRANTON PA
18503-1953
US

V. Phone/Fax

Practice location:
  • Phone: 570-877-5045
  • Fax: 272-235-3568
Mailing address:
  • Phone: 570-877-5045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARSINLEN BLACKWELL
Title or Position: OWNER/ LICENSED COUNSELOR
Credential: LPC
Phone: 570-877-5045